10 Ways to Prevent Mania and Hypomania? You only Need One: Lithium or Another Mood Stabilizer

All the information below is great, but if you aren’t on Lithium, or if you cannot tolerate that, then another mood stabilizer, then you can practice these steps till the cows come home, but you most likely will not be able to avoid hypomania or full blown mania.

So take your Lithium or whichever mood stabilizer is right for you. Lithium is just the GOLD standard in Bipolar d/o treatment, therefore I keep talking about it. Take your medication and stay out of trouble. You can even practice all 10 or as many steps below as you like, that won’t hurt you. What will hurt is not taking your meds.

So, have I said “Take you meds, stay on your meds, don’t come off your meds!” And life will be peachy!

“10 Ways to Prevent Mania and Hypomania

Bipolar disorder is one of the most difficult illnesses to treat because by addressing the depression part of the illness, you can inadvertently trigger mania or hypomania. Even in Bipolar II, where the hypomania is less destabilizing than the often-psychotic manic episodes of Bipolar I, persons often experience from a debilitating depression that can’t be lifted by mood stabilizers and antipsychotics. Antidepressants, though, can cause a person with bipolar to cycle between hypomania and depression.

I have worked with psychiatrists who were too afraid of cycling to risk using antidepressants for bipolar patients. They put me strictly on mood stabilizers and antipsychotics. However, I did not get well. I stayed depressed, and all original thoughts in my brain vanished. My current psychiatrist knows that depression is my primary threat, not so much the hypomania, so she was able to pull me out of the depression with the right combination of antidepressants, but is vigilant for any signs of hypomania. Because I know how vulnerable I am to hypomania, I have learned several strategies to help me stay grounded. By making them part of my life, I have been able to take less lithium, my mood stabilizer, which ensures that I continue producing original thoughts and not get too medicated. Here are 10 tools I use to avert hypomania.

1. Practice Good Sleep Hygiene

Developing good sleep habits is by far the most potent tool for preventing mania and hypomania. There are a handful of studies documenting that sleep deprivation is associated with mania and hypomania. By going to bed at 10 every night and sleeping a good eight or nine hours, we have the power to stop rapid cycling and to reverse mania or hypomania. In a study published in Biological Psychiatry a rapid-cycling patient was asked to remain on bed rest in the dark for 14 hours each night (gradually reduced to 10 hours). Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. His sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. The abstract’s conclusion: “Fostered sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.”

Good sleep hygiene means you go to bed at the same time every night, ideally before 10:30 p.m. — not one night 2 a.m. and another night 7 p.m.; you sleep at least eight hours a night; and you wake at the same time in the morning. Since many folks with bipolar disorder havesleep disorders, a nighttime routine is often needed. For example, I shut down my computer at 8 p.m. and try not to check my emails or messages on my phone. Reading a disconcerting email at 9 p.m. will keep me up all night. It takes me a good two hours to calm down, so I get out the lavender oil around 8:30 p.m., pull out a real book (not an iBook), and begin to tell my body it needs to seriously chill out.

2. Limit Your Screen Time

CNN did a story a few years ago on iPads (or LCD screens) and sleep. Journalist John D. Sutter asked Phyllis Zee, MD, a neuroscience professor at Northwestern and director of the school’s Center for Sleep & Circadian Biology, if our gadgets can disturb sleep patterns and exacerbate insomnia. Dr. Zee said:

Potentially, yes, if you’re using [the iPad or a laptop] close to bedtime … that light can be sufficiently stimulating to the brain to make it more awake and delay your ability to sleep. And I think more importantly, it could also be sufficient to affect your circadian rhythm. This is the clock in your brain that determines when you sleep and when you wake up.

I absolutely know that to be true, because for awhile, I was reading iBooks for a half-hour before bed and staying awake until 2 a.m. My concern with LCD screens isn’t limited to bedtime. I know from people in my depression community that persons with bipolar disorder have to be careful with LCD screens at all times, as they can make the highly sensitive personhypomanic if the person doesn’t take a break from them. For me and for many fragile persons with bipolar, looking into an LCD screen for too long is like keeping your light therapy sunboxon all day. I made the mistake of firing up that baby from 9 p.m. to midnight right after I got it, and I did not sleep one iota the next day, and felt hypomanic all day long. Keep in mind that not only is the light stimulating, but so is all of the messages and tagging and poking — especially if you have as many social media handles as I do.

3. Avoid Certain People and Places

Most of us have a few people in our lives that appear as though they’ve downed three shots of espresso every time we see them. They are usually great fun and make us laugh. However, the hyperactivity isn’t what you need if you haven’t slept well in a few weeks and are trying to calm down your body and mind. Same goes with places. I don’t dare step foot inside the mall, for example, between Halloween and New Year’s. There is just too much stuff being forced in front of my face. I also hate Toys-R-Us. I still have nightmares about the time my husband pressed three dozen Tickle Me Elmos and the entire shelf began to shake.

4. Pay Attention to Your Body and Breathe Deeply

Before attending the mindfulness-based stress reduction (MBSR) program modeled after the one developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, I did not pay attention to my body’s cues preceding a hypomanic episode. In fact, it was usually another person who would point out the embarrassing truth — like the time my editor wrote a letter to my doctor after I started publishing eight blogs a day thinking my traffic would go up. Now, though, when my heart races and I feel as though I have consumed eight cups of coffee, I know this is my opportunity to reverse my symptoms by doing lots of deep breathing exercises.

By voluntarily changing the rate, depth, and pattern of breathing, we can change the messages being sent from the body’s respiratory system to the brain. In this way, breathing techniques provide a portal to the autonomic communication network through which we can, by changing our breathing patterns, send specific messages to the brain using the language of the body, a language the brain understands and to which it responds. Messages from the respiratory system have rapid, powerful effects on major brain centers involved in thought, emotion, and behavior.

5. Eliminate Caffeine

A good caffeine rush mimics hypomania. You feel more alive, more alert, like you could actually contribute something of worth to the world. That’s all fine and dandy except when you are teetering on the hypomanic edge. Caffeine can provide the ever-so-subtle push to the other side, especially if you aren’t sleeping well, which is when most people most crave caffeine. Stephen Cherniske, MS, calls caffeine “America’s number one drug” in his bookCaffeine Blues because of the withdrawal our body goes through three hours after we’ve drank a cup of coffee or a Diet Coke. Persons with bipolar are even more sensitive to amphetamine-like substances that raise dopamine levels, so the safest way to prevent hypomania is to eliminate the stuff altogether.

6. Exercise

My best workouts have been when I’m either on the verge of becoming hypomanic or when I am ticked off. My usual 10-minute mile goes down to an eight. I start passing people along my route, at the Naval Academy, feeling like Lynda Carter in her Wonder Woman getup. And my swim interval is consistent with the people who swam across the Chesapeake Bay in under two hours. The truth is I have averted many hypomanic episodes by working out until I collapse or at least become tired, which can take a few hours. Two years ago, the only way I was able to sleep was by swimming more than 300 laps a day. There are people for whom vigorous exercise triggers mania, but most experts report on the benefits of exercise for bipolar disorder.

7. Watch Your Sweets

There is a reason why ice cream, Swedish Fish, and animal crackers are comfort food for the bipolar person. The rush of insulin generated by those foods will calm those carbohydrate-craving brain pathways for a bit, until a crash in blood sugar has the person binging again on sweets. It’s a vicious cycle, one that can keep a bipolar person cycling indefinitely.

I will tell you a true story about sugar and bipolar. About 16 years ago, before I knew I wasallergic to sugar and that a high-carb diet was the worst thing I could do for my mental health, I would sometimes drink two bottles of Arizona Iced Tea and eat two or three chocolate-chip oatmeal bars for lunch. One day, there was a Horizon milk truck in front of our house with a large cow on the side. I started mooing at the cow. My new husband, behind me, was truly frightened by this and told me to lay off the Arizona Iced Teas and granola bars for awhile. I haven’t mooed at a truck since.

8. Be Careful With the Opposite Sex

I am all for good, healthy friendships between men and women. If you’re not bipolar. Consider me a prude, but I know how difficult it can be to be consistent with good boundaries if you are even the tiniest bit hypomanic. You sincerely didn’t mean for something you sent in an email to sound flirtatious — you were just being playful, like you are with your girlfriends. However, when you do get a reaction from a person of the opposite sex, something in the least bit flattering, that communication can ignite a rush that sends a signal throughout your entire body that you want more of the feel-good hormone it just experienced — dopamine, essentially. It’s even riskier if you have a history of substance abuse and bipolar — because your body will compromise any moral agreements you have signed off on prior to that email in order to get that damn rush again. If you’re not careful, this dangerous game will trigger a full blown manic episode. I have had the best intentions with 85-year-old men, and still, somehow, found myself in trouble. So for the time being, I’m sticking to female friendships.

9. Use a Shopping List

One of the most common manic behaviors is uncontrollable spending or shopping. Therefore, it is sometimes helpful for persons with bipolar disorder to make out a list beforehand of the items you absolutely need to buy — be it a grocery list, a Home Depot run, or a mission to get a your daughter’s friend a birthday gift. That way you won’t end up with 20 different kinds of paint swatches for the kitchen and living room you’ve decided to paint while you were at the store.

10. Allow Time to Decompress

This one is probably the second most important for me to prevent mania. I would say meditate, but that word produces too much expectation and pressure for me right now. Decompressing means after you finish something like a blog post or after you’ve forced yourself to be social for a few hours at a party that you didn’t want to attend, you allow yourselves 15 to 30 minutes to look at the ceiling fan in your bedroom and think about just that: the ceiling fan.

The case has been made that persons with bipolar disorder are creative and therefore need more chill time than the average person. Our brains are operating at a faster pace and more intensely than our non-bipolar friends for the periods of time where we must appear normal. So it is absolutely imperative that we allow some time where nothing is required — where we can drool, or lie in the grass, or doodle, or collapse in front of the front door. Although it seems as though these hours are unproductive, this activity will rebuild the gray matter of our brains and safeguard us from a manic episode.”

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9 thoughts on “10 Ways to Prevent Mania and Hypomania? You only Need One: Lithium or Another Mood Stabilizer”

#4 is very important to me. It’s somewhat easier to control a manic episode if I pay attention to everything I do and slow down. I slow down all my movements and my speech, breathing helps to slow down my mind.

I take Trileptal, which is my mood stabilizer and Klonipin (Benzo/anti-anxiety med.) to help with for my constant rapid cycling and absolutely terrible mixed episodes that are so crazy awful. I am usually hypomanic, so the Clonipin is an absolute life saver. I would be flying to the moon constantly without it. My Bipolar DIsorder 1 cycles from Hypomanic to a debilitating dark grave like empty emotionless dead like feeling of depression with suicidal ideations and severe thoughts of death. I never have a middle ground. I rapid cycle from Hypomainia to depression. I cannot take any other medications other than those two that I am on and believe me I have tried them all. I am very sensitive to medications and side effects. if I take an anti-depressant I will go into a full blown mania which is like a hell for me…. woah! The list you wrote is awesome. I know I need to give up caffeine but I am addicted. I must try to quit again. I have done it before but it is my treat and a gift for myself even though I know that it is very bad and dangerous for me. Naughty me. I also can’t make my self exercise . The last time I did workout at the YMCA I injured my knee as I have arthritis and am getting old and am very fat and out of shape I have no problem staying away from men right now as I do not like myself much so I can’t expect them to like me back…. if you know what I mean. Plus, there are absolutely no good men in the area I love. Believe me many years ago after my divorce I looked especially when I was in a full blown mania. Ugh!!!
I so agree with you. Stay on your medications always always always. My medications can’t seem to stop the depression from creeping up but at least I have not ever reached a full blown destructive “bad” mania episode on my mood stabilizers! That is awesome!!!. Thanks for your awesome blog!!! Great again!!! May your beautiful Bipolar basket stay healthy and happy and overflow with blessings always!!!

Oh no, I am so sorry, it sounds like your illness is very difficult to manage! So sorry about the dark depressions, I know about those as well. Luckily I don’t have rapid cycling and I can take lithium. I am so happy you have medications you can take and that help you! Can you walk? That’s good exercise and easy on your joints. And yes I know what you mean about caffeine, I absolutely have to have my coffee after I wake up, cannot do without it. Best wishes to you, we all just have to do the best we can.

Thanks for your reply. Sorry I have been so slow in returning a response to you. I wish I was better and would walk and would exercise. I have been so bad at that. My mind goes a mile a minute and feels like I am running a marathon while I am sitting down….. I seem to get tired out with my racing thoughts each mile I do not run…. so I don’t know why I just don’t get up and run that mile that is in my brain. Hmmmm…..so you would think I would be so thin from keeping up with my mind but it seems to go the opposite direction. Sometimes with my mixed episode symptoms it is like my brain is in too much conflict fighting with itself that it cannot make up its mind to walk and exercise or this is my excuse for my lack of motivation to exercise… Plus, I have some arthritis so the last time I exercised I overdid it like everything I do, I guess that maybe related to my rapid thoughts hypomania junk…. I thought at least while I am here or there actually I am going to really work out. Well that was not a good idea for an older overweight out of shape person. So I hurt my knee and now have let so much time pass and I cant afford a new membership now. This is still not an excuse as I have a treadmill in my house used for hanging up clothes on….. hahaha….. I must start though. I hate my body size etc. etc. it really bothers me a lot and I know walking/exercising would help my Bipolar symptoms. I should start blogging my progress on that and maybe that would help….. hmmmm….just thought of that as I am typing to you so thank you for the brilliant idea!!!! If you get a chance and have anytime maybe you an check out my new posts and see if you like them… I have been trying to write more…. I am still learning and have so much to learn yet. Have a great day!!!

Hypomanic, me. For 5 days out of 9. exhausting. Sure I get things done, research items to death…
But I’d rather be sleeping. I follow strict regimens of sleep, I am Whole Foods ( no processed stuff ),
Plant based, i exercise every day…..what the heck. I should know better….had this most of my life.
Na ja ( oh well ). Lithium.